Dr. Mridula Prasad's Small Revolution.

Dr. Mridula Prasad, a Munster, Indiana, neurologist, has created a network of alternative long-term-care living arrangements for people with multiple sclerosis in Lake County, Indiana. In doing so, she has launched a small revolution.

Mridula Prasad's transformation from a caring physician to a physician crusading for alternative care options for her patients with severe disabilities began in mid-1997. She was treating a woman with MS in her early 40s who had been hospitalized with severe depression. Dr. Prasad vowed to keep the woman from returning to the nursing home where she had been living. When no other alternative was available, Dr. Prasad decided that a townhouse she owned near the hospital would be the best place for her patient. Shortly afterwards, 2 more of her patients with MS who were in similar situations moved in.

Today, Dr. Prasad takes care of the mortgage payments and some of the care, and the residents pool their resources to pay for utilities and food. Dr. Prasad, her husband, and their 3 daughters are also sharing their own home with yet another patient and her teen-age son who has severe disabilities.

Neighbors of the townhouse, upset by the increased traffic from caregivers, maintained that Dr. Prasad was operating a nursing home in the neighborhood, and the zoning board imposed fines of nearly $5,000. The case was resolved in Dr. Prasad's favor on grounds that the zoning code violated the Federal Fair Housing Act.

This controversy had the unintended effect of publicizing Dr. Prasad's cause--including an article in a November 1998 issue of People magazine. The publicity spurred a Methodist congregation in nearby Valparaiso to renovate a bungalow for use by 2 more of Dr. Prasad's patients with MS and serious housing problems. To capitalize on this momentum, Dr. Prasad and supporters from the community have formed a foundation, "People Helping People".

For her extraordinary contributions to people with MS, Dr. Prasad was recognized last October by the National MS Society with its first "Making A Difference Award". She joined the board of the Society's Indiana Chapter just over a year ago.

What drives Mridula Prasad? "I get frustrated at not having any answers for my patients. I find MS to be the most devastating of diseases ... it takes over," she said.

Dr. Prasad, originally from India, is a reserved woman--except when it comes to MS. Why would a successful physician, who is married to another successful physician and has her own family, throw herself so ardently into a cause--even to the point of opening her home to relative strangers? "It depends on what satisfies you in life," she answered, quickly switching the conversation to the needs of those she serves.

Her patients can't say enough good things about her. "She's just a magnificent human being," said Joe Massa, 57, who lives in the townhouse. "There was Mother Theresa in India, and now we've got her in Indiana."

Dr. Prasad has the most concern for people with very severe MS who are living in nursing homes at a young age. "They are confined to a bed, they cannot move, and they do not get the care they need. They are just there. That's their life," Dr. Prasad said, explaining why people in this situation may become depressed and gradually lose the will to accept therapy, and eventually the will to live.

"I think physicians need to look at this problem. I'm sure a lot of doctors feel as I do, but because the problem is so difficult, they do not get as emotionally involved as I do," she said.

The National MS Society estimates that nearly 90,000 of the people in the United States who have MS will need some form of long-term care. Nursing home care is costly and of uneven quality, and it is largely geared to geriatric residents. However, the alternative of caring for people in their own homes, or in a home-like setting, is not adequately covered by state or federal health-care programs, and is enormously expensive. Private long-term-care health insurance policies can rarely be purchased after a person is diagnosed with a potentially disabling disease. The Society's Long-Term Care: Community Living Options Committee is currently working with the government and private insurers to explore ideas for people with MS. (See Winter 1999, pages 43-45.)

Community action is an option. Don Evans, the attorney who successfully defended Dr. Prasad in the zoning case, was instrumental in rallying his church and his community to establish a second cooperative living situation. "It's exciting," he said. "I hope what we have done can be a model for the rest of the nation to follow once we work out the kinks."

While the national debate about long-term care options continues, Mridula Prasad's priority will remain improving the quality of life of the people in her care. Everyone in the 2 cooperative living settings has shown improvement. Several have become more mobile and are again pursuing interests they discontinued when they became disabled. One woman who was severely depressed no longer needs antidepressant medication.

Dr. Prasad's approach to the problem is personal and straightforward. "We all have to depend on one another. We all have to realize we have a responsibility. The family alone cannot handle the burden. We as a society should not sit by and watch."

She adds that while the issue of providing appropriate long-term care for those with MS seems daunting at first, it's not impossible. "It's not very hard to give a little bit."

Marty Doorey, a freelance writer, is vice chairman of the Society's Upstate New York Chapter He has MS.